Provider First Line Business Practice Location Address:
505 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-519-0257
Provider Business Practice Location Address Fax Number:
304-529-7848
Provider Enumeration Date:
08/08/2006